| NPI | 1568916724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 7627) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 100610) |
| 122300000X Dentist (Licence: AK 113885) | |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2023-06-02 |